Progressive occlusive thrombarteriopathy: a case report

A case of occlusive arterial disease of obscure nature and etiology is reported. The most puzzling aspect of this case was an apparent lack of correlation between the acute, progressive clinical course of the disease, especially in its final stages and the absence of any corresponding acute changes on microscopic examination of the affected vessels. Furthermore the combination of clinical features and pathologic findings--particularly the thrombotic involvement of the heart and the thoracic aorta by a process starting in the small and medium size vessels of the lower extremities--is not consistent with any of the recognized syndromes leading to a thrombotic occlusion of the arterial system. We conclude that the case represents an obscure syndrome of progressive occlusive thrombarteriopathy, perhaps related to a cumulative effect of heavy smoking, alcoholism, and drug addiction. It is possible that increased coagulability of the blood contributed to the thrombotic process but was not recognized by means of the hematologic studies performed.